| NPI | 1356584254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.207851) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 273544) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2015-09-25 |